Evolution of surgical management of gallbladder carcinoma and impact on outcome: Results from two decades at a single-institution Journal Article

   

Authors:	Creasy, J. M.; Goldman, D. A.; Gonen, M.; Dudeja, V.; O'Reilly, E. M.; Abou-Alfa, G. K.; Cercek, A.; Harding, J. J.; Balachandran, V. P.; Drebin, J. A.; Allen, P. J.; Kingham, T. P.; D'Angelica, M. I.; Jarnagin, W. R.
Article Title:	Evolution of surgical management of gallbladder carcinoma and impact on outcome: Results from two decades at a single-institution
Abstract:	Background: The surgical approach to gallbladder cancer (GBCA) has evolved in recent years, but the impact on outcomes is unknown. This study describes differences in presentation, surgery, chemotherapy strategy, and survival for patients with GBCA over two decades at a tertiary referral center. Methods: A single-institution database was queried for patients with GBCA who underwent surgical evaluation and exploration and was studied retrospectively. Univariate logistic regression was used to assess the relationship between time and treatment. Univariate Cox proportional hazard regression assessed the association between year of diagnosis and survival. Results: From 1992 to 2015, 675 patients with GBCA were evaluated and 437 underwent exploration. Complete resection rates increased over time (p < 0.001). In those submitted to complete resection (n = 255, 58.4%), more recent years were associated with lower likelihood of bile duct resection and major hepatectomy but greater odds of neoadjuvant and adjuvant chemotherapy (p < 0.05). No significant association was found between year of diagnosis and OS or RFS (p > 0.05) for patients with complete resection. Conclusion: Over the study period, GBCA treatment evolved to include fewer biliary and major hepatic resections with no apparent adverse impact on outcome. Further prospective trials, specifically limited to GBCA, are needed to determine the impact of adjuvant chemotherapy. © 2019 International Hepato-Pancreato-Biliary Association Inc.
Keywords:	adult; cancer chemotherapy; cancer survival; controlled study; human tissue; treatment outcome; aged; cancer surgery; major clinical study; cancer adjuvant therapy; cancer diagnosis; surgical approach; proportional hazards model; liver resection; biliary tract surgery; gallbladder carcinoma; very elderly; human; male; female; article; tertiary care center
Journal Title:	HPB
Volume:	21
Issue:	11
ISSN:	1365-182X
Publisher:	Elsevier Science, Inc.
Date Published:	2019-11-01
Start Page:	1541
End Page:	1551
Language:	English
DOI:	10.1016/j.hpb.2019.03.370
PUBMED:	31027875
PROVIDER:	scopus
PMCID:	PMC6812599
DOI/URL:	https://www.scopus.com/inward/record.uri?eid=2-s2.0-85064559367&doi=10.1016%2fj.hpb.2019.03.370&partnerID=40&md5=7a2c392a92d09a43f97dde7f529414df
Notes:	Source: Scopus